Hailey Tran
Constipation is a common condition that can often be treated with home remedies and over-the-counter medications. However, severe or persistent constipation can be a medical emergency and may require hospital treatment. Inpatient treatment for constipation typically involves identifying and addressing the underlying cause, which could be related to medication use, dehydration, or dietary and lifestyle factors. Treatment options in a hospital setting range from conservative methods such as hydration, mobilization, and laxatives to more invasive procedures like disimpaction, colon resection, and, in rare cases, surgery.
| Characteristics | Values |
|---|---|
| Cause of constipation | Opioids, inadequate fiber intake, dehydration, diet or routine changes, intestinal issues, underlying health conditions, behavioral habits, aging |
| Assessment | Symptom assessment, patient history, medication use, physical examination, patient assessment tools, radiographic imaging |
| Treatment | Laxatives, saline laxatives, polyethylene glycol, enemas, intestinal secretagogues, opioids antagonists, manual disimpaction, surgery, medication, lifestyle changes, diet and exercise changes, increased water and fiber intake |
| Complications | Hemorrhoids, anal fissures, bowel incontinence, rehospitalization, reoperation |
| Emergency symptoms | Severe abdominal pain, vomiting, blood in stool, severe stomach pain, large amount of blood in stool, chronic constipation |
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What You'll Learn
Laxatives, enemas, and other medications
Constipation is a common problem that can sometimes become chronic or indicate a medical emergency. It occurs when bowel movements become less frequent and stools become difficult to pass. This can be due to changes in diet, inadequate fiber intake, dehydration, underlying health conditions, or certain medications. Opioid-induced constipation is a common cause in hospitalized patients.
Laxatives are often used to treat constipation, but they should be approached with caution as they can have gastrointestinal side effects such as bloating, diarrhea, and abdominal fullness. Saline laxatives and polyethylene glycol are preferred over non-absorbed sugars and sugar alcohols like lactulose and sorbitol, as the latter can cause undesirable gas and bloating. Stimulants are another type of medication that activates sensory nerve endings to promote colonic motility and reduce water absorption in the colon. Stool softeners work by allowing water and lipids to penetrate and soften the feces, while lubricants facilitate defecation by lubricating the gut lining.
Enemas are also commonly used to treat constipation. Fecal impaction, a severe form of constipation, may require medical disimpaction to remove the blockage from the rectum. In addition to laxatives and enemas, there are several prescription drugs available to treat constipation, including Lubiprostone (Amitiza®), Prucalopride (Prudac®, Motegrity®), Plecanatide (Trulance®), Lactulose (Cephulac®, Kristalose®), and Linaclotide (Linzess®). A healthcare provider will determine the most suitable medication based on the patient's condition and test results.
In some cases, constipation may be addressed through lifestyle changes, such as increasing fiber and water intake, adjusting diet, and making changes to exercise routines. However, chronic constipation that persists or recurs should be discussed with a doctor to determine the best treatment options. Surgery is rarely needed to treat constipation, but it may be recommended if there is a structural problem in the colon, such as a blockage, intestinal stricture, anal fissure, or rectal prolapse.
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Surgery and other procedures
Surgery is rarely needed to treat constipation. However, in some cases, it may be recommended if a structural problem in the colon is causing constipation. For instance, if a colonoscopy reveals cancer in the colon, rectum, or anus, surgery may be necessary. Other structural problems that may require surgery include a blockage or intestinal obstruction in the colon, a narrowing of the intestine (intestinal stricture), a tear in the anus (anal fissure), or the collapse of part of the rectum into the vagina (rectal prolapse).
In cases where surgery is not required, there are other procedures and treatments available to manage constipation. One option is the use of prescription drugs, such as lubiprostone (Amitiza®), prucalopride (Prudac®, Motegrity®), plecanatide (Trulance®), lactulose (Cephulac®, Kristalose®), and linaclotide (Linzess®). The choice of drug will depend on the patient's specific needs and test results.
Another procedure that may be recommended is a colostomy, where a surgeon creates an opening in the abdomen to allow stool to pass into a collection device. This is often necessary when constipation and impaction have led to straining, which can cause stress on incisions and, in extreme cases, cause them to open.
Additionally, constipation can be managed through dietary changes and increased physical activity. Eating a well-balanced diet with adequate fiber and fluids can help prevent constipation. Good sources of fiber include fruits, vegetables, legumes, and whole grains. It is recommended to consume between 18 and 30 grams of fiber daily. However, it is important to note that taking fiber supplements after surgery without sufficient water intake can worsen constipation. Physical activity, even short walks or moving one's arms and legs while in bed, can help stimulate bowel movements and prevent constipation.
In cases of constipation after surgery, it is important to consult a doctor before using any constipation relief methods, as some may not be safe. Doctors may prescribe stool softeners or recommend over-the-counter laxatives, which can help stimulate bowel movements. Magnesium, a primary ingredient in many laxatives, can relax the bowels and is generally safe for those with mild constipation. However, it is important to consult a doctor first due to the risk of magnesium toxicity.
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Diet and exercise
It is important to increase fibre intake gradually to avoid gastrointestinal issues such as gas, cramping, and bloating. Experts recommend a fibre intake of 25–30 grams per day for women and 30–38 grams for men. Additionally, staying hydrated is essential, as water helps fibre work effectively. Increasing water intake helps soften stools and makes them easier to pass.
Certain diets can contribute to constipation. For example, the keto diet, which is high in fat, can cause constipation. In such cases, consulting a dietitian or doctor to incorporate low-carb fibre sources is advisable. The BRAT diet, comprising bananas, rice, applesauce, and toast, is recommended by dietitians for digestive issues, including constipation.
Exercise is another critical component of constipation treatment. Regular physical activity improves bowel motility and helps move the bowels. It is recommended to engage in some form of exercise daily, even if it is just a 30-minute walk or a swim. For individuals with limited mobility, any amount of regular exercise can be beneficial.
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Opioid-induced constipation
The management of OIC should begin with ensuring the patient is adequately hydrated and has a balanced electrolyte intake. Patients should also be encouraged to mobilise and increase their physical activity. Lifestyle changes should be implemented at the start of opioid therapy and maintained throughout treatment. These include:
- Increasing dietary fibre intake through fruits, vegetables, bran products, and nuts.
- Drinking ample water.
- Exercising to encourage bowel motility.
- Limiting the intake of other painkillers.
In addition to these preventative measures, there are several treatment options for OIC. Lubiprostone (Amitiza) is a medication that increases fluid secretion in the GI tract, enhancing peristalsis and bowel transit times, and increasing the frequency of bowel movements. Other medications used include naloxegol, alvimopan, naldemedine, and oxycodone/naloxone.
Laxatives are also commonly used to treat OIC, with saline laxatives like magnesium citrate and polyethylene glycol preferred over non-absorbed sugars. Stool softeners and stimulants are also used to aid defecation. However, laxatives can have gastrointestinal side effects, including bloating, diarrhoea, and abdominal fullness.
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When to seek emergency treatment
Constipation is a common condition that can often be treated with simple changes to diet and lifestyle. However, in some cases, it may indicate a more serious medical condition that requires emergency treatment. Here are some scenarios when seeking emergency treatment for constipation is recommended:
If You Experience Severe Symptoms
Constipation becomes an emergency when it is accompanied by severe symptoms such as intense stomach pain, severe abdominal pain, major bloating, or vomiting. Fecal impaction, a complication of severe constipation, can cause these symptoms and may require emergency treatment. Fecal impaction occurs when stool becomes backed up in the intestines, often due to chronic constipation, certain medications, dehydration, or laxative use.
If You Haven't Had a Bowel Movement in a Prolonged Time
Constipation that persists for an extended period, such as less than three bowel movements per week, or a complete absence of bowel movements, could indicate a serious health condition. If you haven't had a bowel movement for several days or weeks, it's important to seek medical advice, as this can lead to fecal impaction and other complications.
If You Have Blood in Your Stool
The presence of a large amount of blood in your stool, along with constipation, is a concerning symptom that warrants immediate medical attention. It could be an indication of a serious medical condition affecting the gastrointestinal tract.
If You Are at High Risk for Complications
Certain individuals are at a higher risk for complications from constipation. For example, constipation in toddlers who "withhold" their stool can lead to encopresis, or soiling. Caregivers should monitor toddlers for any signs of constipation and seek medical advice if concerned. Additionally, older individuals, especially those with dementia or learning disabilities, may experience constipation without showing typical symptoms. Behavioral changes, such as confusion, may indicate pain or discomfort due to constipation. In such cases, seeking medical attention is crucial to ensure their comfort and well-being.
If You Have Chronic Constipation
Chronic constipation, or constipation that persists, recurs, or causes concern, should not be ignored. Consulting a general practitioner can help identify any underlying causes and ensure you receive appropriate care. This may involve medications or lifestyle changes, such as increasing water and fiber intake and engaging in regular physical activity.
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Frequently asked questions
You can treat constipation by eating a well-balanced diet with plenty of fibre and drinking lots of water. Good sources of fibre include fruits, vegetables, legumes, and whole-grain breads and cereals. People with constipation should eat between 18 and 30 grams of fibre every day.
Constipation is common, but you should go to the hospital if you have severe abdominal pain, vomiting, or blood in your stool, as these can be symptoms of a more serious condition.
Some prescription drugs that can treat constipation include Lubiprostone (Amitiza®), Prucalopride (Prudac®, Motegrity®), Plecanatide (Trulance®), Lactulose (Cephulac®, Kristalose®), and Linaclotide (Linzess®).
Surgery is rarely needed to treat constipation. However, if a structural problem in your colon is causing constipation, your healthcare provider may recommend surgery. Examples of these problems include intestinal obstruction, intestinal stricture, anal fissure, and rectal prolapse.
Opioid-induced constipation is a common cause of constipation in hospitalized patients. Treatments for opioid-induced constipation include ensuring adequate hydration and electrolyte balance, encouraging patient mobilization, and medications such as laxatives, enemas, intestinal secretagogues, and peripherally acting µ-opioid receptor antagonists.
